Hepatitis B virus infection in hemodialysis patients

Patients with chronic renal failure on hemodialysis suffer from impaired immune defense mechanisms. A defect in costimulatory signalling from antigen-presenting cells (APCs) for the antigen-specific activation of T cells leads to immune incompetence, particularly toward viral infections. The epidemiologic situation of dialysis patients who are treated in centers together with other immunocompromised patients and who need blood access 3 times weekly places them at a high risk for viral hepatitis B. Clinically, the infection shows a mild and subclinical, often anicteric, course, leading to chronic infection in the majority of cases. Typical consequences such as cirrhosis and hepatocellular carcinoma may occur, however, seem to be less frequent than in hepatitis B-infected persons with normal renal function. Protection by vaccination is also hampered by the immune defect. Nevertheless, a high percentage of vaccinated patients is still desirable for infection control. Treatment of hepatitis B in dialysis patients is difficult because interferon-alfa is less effective and frequently leads to side effects. Lamivudine may become a future alternative, however, current experience is limited.